Roche Diagnostics – Lung Cancer Ad Board

Roche Diagnostics – Lung Cancer Ad Board_Roche participants

Roche Diagnostics Advisory Board

Saturday 29th February 2020

09:00-17:00 SGT

The Holiday Inn Singapore Orchard City Centre

11 Cavenagh Rd

Singapore 229616

Agenda TBC

Personal information Travel Dietary requirements

* = required field

First name*

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Last name*

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Title

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Specialty*

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Position held at current institute*

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Institution name*

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Institution department*

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Institution street address*

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Institution town / city*

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Institution postcode / zipcode

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Institution country*

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Correspondence address

Same as institution address

Correspondence street address

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Correspondence town / city

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Correspondence postcode / zipcode

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Correspondence country

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Telephone number*

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Mobile telephone number

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Email address*

Required. Please check email is formatted correctly

Emergency contact details*

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Secretary name

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Secretary telephone number

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Secretary email address

Required. Please check email is formatted correctly

Participants are asked to arrange their own travel

I will organise my own travel and will request a refund
I will organise my own travel and will not request a refund

We will arrange your travel to/from the meeting

Dates

Preferred departure date (dd/mm/yyyy)

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Preferred return date (dd/mm/yyyy)

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Flight Details

Preferred departure airport

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Preferred destination airport

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Frequent flyer numbers

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Name as it appears on your passport

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Date of birth (dd/mm/yyyy)

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Train Details

Preferred departure station

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Preferred destination station

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Preferences

Seat preference (aisle/window)

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Additional travel requirements

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Confirmed arrival date (dd/mm/yyyy)

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Confirmed arrival time

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Confirmed arrival flight number

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Confirmed departure date (dd/mm/yyyy)

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Confirmed departure time (dd/mm/yyyy)

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Confirmed departure flight number

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Special dietary requirements (if applicable)

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Please ensure you have entered the correct information into each required field

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